Provider Demographics
NPI:1639943111
Name:MODERN HEARING, LLC
Entity Type:Organization
Organization Name:MODERN HEARING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:ESHAKSHUKI
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:770-601-7772
Mailing Address - Street 1:3753 GAINESVILLE HWY UNIT 102
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-1001
Mailing Address - Country:US
Mailing Address - Phone:770-601-7772
Mailing Address - Fax:
Practice Address - Street 1:3753 GAINESVILLE HWY UNIT 102
Practice Address - Street 2:
Practice Address - City:ALTO
Practice Address - State:GA
Practice Address - Zip Code:30510-1001
Practice Address - Country:US
Practice Address - Phone:770-601-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech